Metabolic disturbances in the first seizure with fever: Study of children in Thai hospital

Abstract

Background : Seizure with fever is a common neurological manifestation in children, the most common cause of which is febrile seizure. In almost all cases, clinical practice includes laboratory investigation. In spite of multiple studies, no evidence suggests routine blood studies improve pediatric diagnosis.

Objective : Determine association between metabolic disturbances and the first seizure with fever in children.

Methods : Retrospective descriptive study consisting of review of children admitted with first seizure with fever, 3 months to 6 years, from January 1, 2012 to December 31, 2016. Demographics and clinical data, etiology of fever, characteristics of seizure, metabolic laboratory investigations and cerebrospinal fluid profiles were collected. Statistical significance was set at P < 0.05.

Results : The study included 319 children, median age 1.3 years (range 0.17 to 5.83 years). Respiratory tract infection (58%) was the most common etiology of fever. Abnormal laboratory results included anemia for age (25.1%), hyponatremia (24.7%), hypocalcemia (2.3%) and metabolic acidosis (88.1%). Complex febrile seizure was found in 53 cases (16.7%). Comparing simple febrile seizure with complex febrile seizure, statistical significance between the two groups was found only with respect to delayed development and family history of febrile seizure or epilepsy in first degree relatives. Age, sex, duration of seizure, and metabolic laboratory test results were not significantly different between these two groups.

Conclusion : The level of metabolic disturbance was not significantly associated with the febrile seizure. As a result of this study, laboratory investigations are no longer recommended for all patients, except in the presence of clinically suspicious factors.